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The Boston Globe

Metro

Struggle ahead for burn victims

For severely burned survivors of the Rhode Island nightclub inferno, the moment of rescue marked the beginning of a life-and-death struggle that will last weeks, months, even years.

Burn injuries are among the most complex and difficult faced by emergency workers. The victims are vulnerable to massive infection, their bodies deprived of their most vital barrier against colonizing bacteria and viruses - the skin. They endure repeated operations to relieve swelling and to reconstruct their bodies. And they contend with the trauma of disfigurement and unfathomable pain.

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“It’s tragic, absolutely tragic,” said Dr. Alasdair Conn, chief of emergency services at Massachusetts General Hospital, where burn surgeons and trauma specialists expected last night to treat 12 patients from the fire at The Station in West Warwick, R.I., including four at the adjacent Shriners Hospital for Children.

The victims’ journey began before dawn yesterday, as helicopters and ambulances transported them to burn units as far as Boston and Worcester. Rhode Island Hospital in Providence treated more than 60 patients and quickly reached its trauma capacity.

“Has this hospital ever seen anything like this? No,” said Dr. Joseph Amaral, president of Rhode Island Hospital.

The first patient to arrive at Mass. General, about 3 a.m. yesterday, was also one of the most gravely injured. Burns covered 85 percent of his body. Other patients had burns over 35 to 70 percent of their bodies.

The first concern: Could they breathe? “In a tragedy like this,” Conn said, “if you inhale hot gases, you not only can burn your skin, but you have burns of your mouth, your windpipe, and of your lungs.”

As with all victims of serious burns, the patients at Mass. General and Shriners were hooked up to breathing machines. Intravenous lines were set up to deliver antibiotics. Then burn surgeons began assessing injuries and planning treatment.

In the coming hours and days, the victims will make their initial visits to the operating room. The man burned over 85 percent of his body was the first to be operated on, shortly before noon yesterday.

In some cases, surgeons make incisions to reduce swelling. The body, in a sense, turns on itself as it senses the burns, with the result being tissue that becomes so swollen it strangles the blood supply. “It’s as though you’ve applied a tourniquet to your arm or to your legs,” Conn said.

If that swelling happens around the chest, the patient can suffocate. In fact, through the first 48 to 72 hours, the greatest risk is that major organs, such as the lungs, could fail from swelling, infection, and stress.

Patients who survive that period face more time in the operating room. Dead and damaged tissue is excised. Then the rebuilding begins. For some patients, that could begin as soon as this weekend, as surgeons use artificial skin or skin harvested from the patient’s body to start making repairs.

Later, the victims will wear snug clothing called pressure garments, which are designed to keep newly grafted skin intact and promote healing.

The burn unit at Mass. General and Shriners is directed by Dr. Ronald G. Tompkins, who has been chief of staff at Shriners since 1990. Three other surgeons - Robert Sheridan, John Schulz, and Colleen Ryan - worked alongside Tompkins yesterday. Joining them were dozens of nurses. Each of the burn patients will be tended around the clock by at least one nurse assigned exclusively to that person.

“I’ve been a physician for 30 years,” Conn said. “The number of patients we’re receiving and the severity of the burns is unprecedented.”

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